Less is more. Australian clinical practice guidelines for deprescribing in older people.

Introduction

Current treatment guidelines rarely specify when to stop medicines, contributing to potentially unnecessary or harmful medicines use. While deprescribing guidelines exist for some medicine classes, limited guidance is a major barrier to deprescribing. These new Australian clinical guidelines for deprescribing in older people address this gap by providing structured recommendations that complement more detailed drug-specific deprescribing guidance, disease-specific therapeutic guidelines and non-pharmacological management resources. 

Method

The guideline development group of 72 experts, including consumer representatives used GRADE methodology, to develop the guidelines, which were further shaped by feedback from public consultation and independent reviewers. Consensus based recommendations were developed using Delphi methodology.

Results

The detailed guideline is available at https://deprescribing.com. This guideline emphasises deprescribing as an integral part of the prescribing continuum. The guidelines provide 185 consensus-based recommendations and 70 good practice statements, covering both specific medicine categories and general deprescribing principles. The guidelines are structured into four areas: (1) when to deprescribe; (2) ongoing treatment needs; (3) how to deprescribe; and (4) monitoring requirements.

Conclusion

Applying a deprescribing approach encourages prescribers to consider the ongoing need for a medicine each time a prescription is re-issued, to balance benefits and harms as they evolve over time, and to ensure treatment decisions reflect an individual's goals through shared decision-making. The guideline supports health professionals in reviewing regular medicines, minimising harm and planning ongoing treatment or monitoring.